Fine Needle Aspiration Cytology - an overview Nor Hayati Othman Dept of pathology

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Transcript of Fine Needle Aspiration Cytology - an overview Nor Hayati Othman Dept of pathology

  • Fine Needle Aspiration Cytology - an overviewNor Hayati OthmanDept of pathology

  • Historical perspectiveHistopathology >100 years -Last 50 years birth of cytopathology - mainly exfoliative cytologyScandinavia 1950S -1960S ; Sodestroem and Franzen in Sweden and Lopez cardozo in HollandPerformed by professional hybrids - clinicians who used it for rapid diagnosis

  • FNAC - definitionAspiration of cells/ tissue fragments using fine needles ( 22 , 23, 25 G) ; external diameter 0.6 to 1.0 mm1.5 inches long needle ( radiologists use longer needles)Diagnostic materials in the needle and not in the syringe even in cystic lesions

  • Clinical skill requiredFamiliarity with general anatomy eg thyroid vs other neck swellingAbility to take a focused clinical historySharp skill in performing physical examination eg solid vs cystic, benign vs maligant lesions

  • Clinical skill required -2Good knowledge in normal cellular elements from various organs and tissue and how they appear on smears eg fats cells vs breast tumour cellsComprehensive knowledge of surgical pathology

  • Clinical skill required -3Ability to translate traditional tissue patterns of lesions to their appearance in smears

  • Cytology vs HistologyPapillary carcinoma of thyroid - follicular variant

  • Cytology vs Histology - 2Granular Cell Myoblastoma

  • Who should do FNA?CliniciansCytotechnologistsRadiologistsPathologistsThe one who examines the patients , does the aspiration, makes the smears, interprets the cytology is the best one to do FNA -PATHOLOGIST

  • Current statusPalpable lesionsOutpatients , in- patientsThyroid , breast, lymph nodes, salivary glands , soft tissue lumps...Lung, intra-abdominal and retroperitoneal by radiologic imaging : CT, ultrasound, flouroscopy

  • LIMITATIONSSoft vs hard ( bone) lesionsSolid vs cystic lesionsPoor cellular yield vs poor techniqueReactive vs specific diseases eg reactive lymphadenitis vs Hodgkins diseaseDiffuse vs nodular lymphoma

  • ComplicationsNeedle traumagranulation tissue formationgranuloma formationSarcoma like changesNeedle linear tract haemorrhage tissue necrosisInterfere with surgical pathologyNeedle track seeding - testicular tm, chondrosarHematomaPainPneumothorax???

  • ADVANTAGESFast - early diagnosisLess pain, less traumaNo anaesthesiaAcceptable by patients and doctors Accurate

  • How to interpret?Aspiration materials eg colloid, blood, mucus?Cellular yield vs acellular yieldSmear pattern - 3 dimensional balls vs flat monolayered sheet os cellsCohesiveness vs discreet cellsCell morphometry

  • Adjunct toolsCell blocksHistochemistryImmunohistochemistryElectron microscopyFlow cytometryImmuno electron microscopyMolecular pathology -In situ hybridization, PCR etc

  • Adjunct toolsIHCcytologyCell block45 yr old woman with lytic bone lesion Histo - thyroidHisto -bone

  • Future directionsAspirating non palpable lesions using MRIMolecular pathology eg In Situ HybridizationReplacing diagnostic surgical pathology?Combined with MRI - replacing autopsy?

  • FNAC - USM experienceTotal cases per yearKey * up to Sept 14th

  • FNAC - USM experienceType of casesKey * up to Sept 14th

  • FNAC - USM experienceCases under radioimagingKey * up to Sept 14th

  • AcknowledgementEn Mazlan - technologist , for the statistical inputDr zainul Harun - ex USM pathologistAll Master of pathology studentsAll pathologistsRadiologists